Wednesday, December 17, 2008

I Hate Internal Medicine

Last night I was on call for the first time as a resident on the wards (i.e. general medicine inpatient wards, the basic/core inpatient rotation in internal medicine), and more than ever do I hate being a resident in internal medicine.

First of all, it was a busy and brutal night. From the time we opened for admissions at 2pm and until midnight, my pager was going off nonstop. The ER certainly had a non-stop supply of patients that needed to be admitted.

And by "needed to be admitted" I mean patients for whom the easiest thing for the ER to do would be to admit them because they were feeling a little too ill to be at home (or a lot too lazy to want to return home). The ER definitely could have discharged them, but because ER doctors are too spineless and unconfident, the patients were admitted to the hospital. Honestly, a quarter of patients admitted to internal medicine teams are admitted for so-called “social” reasons, referring to reasons like those I’ve just mentioned.

Therein lays my biggest gripe -- to put it politely -- with the night and with the field of internal medicine in general. We get dumped on. We have to admit every patient. We accept every patient the ER decides to admit to the hospital; or every patient from a surgical service that no longer has a surgical issue; or -- and this is the one I absolutely hate the most -- every patient presenting with a surgical problem that the surgery team who’ll tend to it is just too lazy to admit.

(As an example, I just admitted a young man with several neck masses that he had noticed over the last several weeks. He had no other medical problems and was completely stable; and somehow the ENT teams decided he would be better served on a medicine team. All I do every day is look for the latest recommendations by ENT. Seriously, talk about lazy and work-avoidant doctors.)

Ridiculous admissions like these make me hate what I do. Yes I hate what I do, I really do. I feel that if one wants to be an inpatient internal medicine doctor, one must have a pushover personality. There is no other way to survive each day without feeling discouraged and powerless. Fortunately I will be sub-specializing with a fellowship and thus hopefully avoiding such lame admissions in my future career, but I am not sure I can survive another year and a half of this. Each new admission boils my blood and makes me resent even more the patient population at large.

Anyway, let's go back to my night of call. Lucky me, that was only my first night of call this month ... and I have four months of wards left this year. At least I'm paid well.

13 comments:

I hear you, my friend. I'm a senior officer training in general medicine but not in US.

Only a medic can understand the pain of working in hospital medicine.

People who knows what I do always asked me how on earth do I survive with my very long hours.

I admitted Mr.K at 9.30am as my day started at 8am.My day continue after 5pm as I was on call. At night Mr.K got a bit unwell so I attended him again at 10pm and 4am between those non stop admissions from A+E.

The next morning after admitting 35 patients ( it was a busy night!) and a roughly 5 mins-I-fall-asleep-in-a-chair-until-a-crash-bleep-awoke-me, I attended the post call ward round.

I presented Mr. K to the consultant and when we're about to leave to see another patient, Mr. K grabbed my hand and asked gently,"Doc, what time do u finish?". I told him I don't know.

He shook his head and said he's glad he's not a doctor. I smiled and left. After 36 hours of non stop, I returned home to continue the same cycle. Oh, I'm on call again in next two days.

I understand why you would think I'm an "asshole", but unfortunately this is what a typical resident experiences during their training. Not all, but most. Most trainees (interns, residents, fellows, etc.) will admit to similar feelings, if you ask them.

These stories also depict the non-glamorous side of medicine, in my opinion. I'm assuming you are are a pre-med student or something similar, in which case it doesn't hurt to read realities like this.

Also, I am not unprofessional. Professionalism refers to behavior in the hospital and in front of patients. My unsavory opinions are expressed only in this blog or during off-hours, which most people will deem as acceptable ... it's also a healthy outlet.

And finally, this blog is my diary; it just happens to be public. You aren't forced to read it. Regardless, thanks for visiting.

Hi, I am The editor/writer with medicine-worldwide.net. I really liked your site and i am interested in building a relationship with your site. We want to spread public awareness. I hope you can help me out. Your site is a very useful resource.

Please email me back with your URl in subject line to take a step ahead and also to avoid spam.

Every healthcare provider should switch to an EMR solution. Paper based records and prescriptions are a thing of the past now and it would be best for both doctors and patients to take advantage of their features and accessibility.

I am a medical student and you residents make my life miserable. so what.

your attitude is what is wrong with the health care system

you knew what internal medicine was like when you were in my shoes, you still went into it.

So know you hate your job, you feel powerless and you exert your self hatred on the lowest of the food chain, medical students.

i feel absolutely no pity for you. i am tired of medical sub specialist wannabees griping through an internal medicine residency, hating it every step of the way making each day excruciating painful for everyone in there path.